Royal United Hospitals Bath NHS Foundation Trust has been told to take action to ensure safe staffing levels across accident and emergency, critical care and medical wards.
There were periods where staffing and skill mix were “not as planned by the trust”, said the Care Quality Commission following its inspection.
“There were periods where staffing and skill mix… were not as planned by the trust”
The CQC noted that the problem was mitigated by higher numbers of healthcare assistants and, in some cases, supervisory ward sisters acting in a clinical capacity.
Although there were systems in place to “flex” nurse staffing across wards, these relied upon the judgement of senior staff rather than being grounded in clear processes, added the CQC.
The regulator acknowledged there a process in place to authorise the use of agency staff, recruitment was ongoing for nursing vacancies and the trust was training assistant nurse practitioners in order to provide additional support.
The CQC told the trust it must take steps to ensure that the emergency department was “consistently staffed to planned levels to deliver safe, effective and responsive care”.
It must also take action to ensure staffing reviews are “robust and reflect accurate and comprehensive data for all medical wards”, said the regulator in its inspection report.
“We fully accept that there are some areas in which we need to improve”
Additionally, the trust was told to continue to mitigate the risks associated with less than planned staffing levels to ensure safe staffing on medical wards for every shift.
In critical care, the trust must review nursing levels to ensure they met those recommended in guidance and ensure the correct policy was followed when moving nurses to work on other wards.
The trust needed to employ an experienced nurse to the post of critical care matron, a post that has been vacant for 15 months, added the CQC.
The team of inspectors visited Royal United Hospitals Bath and Royal National Hospital for Rheumatic Diseases between 15 and 18 March 2016.
Overall, the regulator rated the trust as “requires improvement”, though it was described as “outstanding” for being caring.
Meanwhile, it was rated “requires improvement” for being safe and responsive to people’s needs, and as “good” for being effective and well led.
The CQC identified a number of areas of outstanding practice including “numerous examples” of compassionate end of life care provided by nursing, medical and cleaning staff.
“We are delighted the CQC have rated the overall care given to our patients as outstanding”
The orthopaedic and fracture clinic was also highlighted for having a sensory box – containing objects and picture books – that could be used as part of distraction therapy for children or patients with dementia or a learning disability.
Professor Edward Baker, CQC deputy chief inspector of hospitals, said: “There is a strong safety culture at the trust with a leadership at all levels which encourages openness and transparency.
“However, there were periods where staffing and skill mix at the Royal United Hospital were not as planned by the trust, especially in the busiest times in the emergency department and on some medical wards,” he said.
But Professor Baker highlighted the outstanding caring levels throughout the trust, especially in children and young peoples’ services and end of life care where patients were “universally positive”.
Trust chief executive James Scott said: “Whilst we are disappointed with our trust’s overall rating, we are delighted the CQC have rated the overall care given to our patients as outstanding.
He added: “We recognise, and it’s no secret, that our hospital is under pressure, particularly in urgent and emergency care, and this is something we are working to address. Our staff work incredibly hard.”
Helen Blanchard, director of nursing and midwifery at the trust, said: “It’s testament to all our staff that the inspection team found our patients are treated with kindness, compassion, courtesy, dignity and respect throughout our organisation.
“We fully accept that there are some areas in which we need to improve,” she said. “We continue to make sure that we have the right staffing levels across our hospitals, and we have been actively trying to recruit more nurses in particular for a number of months.”
She added: “Work to address issues in relation to documentation and record keeping in some departments was already underway at the time of the inspection.”
The trust serves a population of around 500,000 across Bath, North East Somerset and Wiltshire.